Does meloxicam cause constipation? Learn about the potential side effects, interactions, uses, dosage, and warnings of this generic prescription medication.

Meloxicam Side Effects: How to Manage

Meloxicam (Mobic, Anjeso) is a generic prescription medication used to treat osteoarthritis, rheumatoid arthritis (RA), and juvenile RA. It is available as an oral tablet and capsule. As with any drug, meloxicam can cause side effects, some of which are more common than others.

Common Side Effects of Meloxicam

Some of the more common side effects reported by people who took meloxicam in clinical trials include:

• Upper respiratory infection, such as the common cold
• Flu-like symptoms, such as fever, chills, or sore throat
• Digestive problems, such as abdominal pain, constipation, and diarrhea
• Headache*

*For more information about this side effect, see “Side Effect Specifics” below.

Mild Side Effects of Meloxicam

Mild side effects that have been reported with meloxicam use include:

• Mild infections, such as urinary tract infection (UTI) and upper respiratory infection
• Flu-like symptoms, such as fever, chills, or sore throat
• Dizziness
• Back pain
• Insomnia
• Rash or itchiness
• Sleepiness or drowsiness
• Digestive problems, such as abdominal pain, constipation, and diarrhea
• Weight gain or weight loss*
• Headache*
• Joint pain*
• Mild allergic reaction*

*For more information about this side effect, see “Side Effect Specifics” below.

Serious Side Effects of Meloxicam

Meloxicam may also cause serious side effects. If you develop any of the following symptoms, call your doctor right away or seek immediate medical attention:

• Anemia (low level of red blood cells) – Symptoms can include lightheadedness, pale-looking skin, and shortness of breath.
• High blood potassium level – Symptoms can include nausea, vomiting, shortness of breath, muscle cramps, and heart palpitations.
• Severe skin reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms – Symptoms can include fever, swollen lymph nodes, a painful rash, and blisters or peeling skin around the eyes, mouth, or throat.
• Fluid buildup, which may occur in the face, arms, or legs – Symptoms can include weight gain, shiny or swollen skin, and pain or stiffness around the affected area.
• Kidney damage – Symptoms can include fatigue, nausea, vomiting, loss of appetite, and muscle cramps.
• Liver damage – Symptoms can include fatigue, nausea, diarrhea, pain in the upper right abdomen, and jaundice.
• High blood pressure, which doesn’t typically cause symptoms.
• Heart problems*
• Digestive system problems*
• Severe allergic reaction*

*Meloxicam has a boxed warning for this side effect, which is the most serious warning from the FDA.

Side Effect Specifics

Meloxicam may cause certain side effects, such as headaches, weight changes, joint pain, and allergic reactions, that require more detailed information:

Headaches

Headaches are a common side effect of meloxicam. If you experience persistent or severe headaches while taking this medication, talk to your doctor. They may be able to recommend ways to manage the headaches, such as adjusting your dosage or trying over-the-counter pain relievers.

Weight Changes

Meloxicam can sometimes cause weight gain or weight loss. If you notice any significant changes in your weight while taking this medication, discuss it with your doctor. They may be able to help determine the cause and recommend ways to manage it.

Joint Pain

Some people report experiencing joint pain while taking meloxicam. If this occurs, talk to your doctor. They may be able to suggest ways to alleviate the pain, such as adjusting your dosage or trying a different medication.

Allergic Reactions

Meloxicam can cause mild allergic reactions, such as rash or itchiness. However, it can also cause more serious allergic reactions, which are considered a boxed warning for this medication. If you experience any signs of an allergic reaction, such as difficulty breathing, swelling, or a severe rash, seek immediate medical attention.

Meloxicam Side Effects in Children

Meloxicam is approved to treat juvenile rheumatoid arthritis in children weighing at least 60 kilograms (about 132 pounds). Most side effects are expected to be the same as in adults, but the following side effects may be more common in children:

• Certain digestive problems, such as diarrhea, vomiting, and abdominal pain
• Fever
• Headache

If you have any concerns about your child’s use of meloxicam, be sure to discuss them with their doctor.

Reporting Side Effects

If you develop a side effect while taking meloxicam and want to report it to the FDA, you can visit MedWatch.

Meloxicam oral tablet side effects: How to manage

Meloxicam (Mobic, Anjeso) is a generic prescription medication. Meloxicam comes as an oral tablet and oral capsule. Both forms of meloxicam are used to treat osteoarthritis. In addition, meloxicam oral tablet is used to treat rheumatoid arthritis (RA) and juvenile RA.

Meloxicam may be used as a short-term or long-term treatment. As with other drugs, meloxicam can cause side effects.

This article focuses on just the oral tablet form of meloxicam, which is available as the brand-name drug Mobic. Read on to learn about its potential common, mild, and serious side effects. For a general overview of meloxicam, including details about its uses, refer to this article. Your doctor can also tell you more about meloxicam.

Meloxicam can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took meloxicam in clinical trials:

• upper respiratory infection, such as the common cold
• flu-like symptoms, such as fever, chills, or sore throat
• digestive problems, such as abdominal pain, constipation, and diarrhea
• headache*

* For more information about this side effect, see “Side effect specifics” below.

Mild side effects can occur with meloxicam use. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to meloxicam’s prescribing information.

Mild side effects that have been reported with meloxicam include:

• mild infections, including urinary tract infection (UTI) and upper respiratory infection, such as the common cold
• flu-like symptoms, such as fever, chills, or sore throat
• dizziness
• back pain
• insomnia
• rash or itchiness
• sleepiness or drowsiness
• digestive problems, such as abdominal pain, constipation, and diarrhea
• weight gain or weight loss*
• headache*
• joint pain*
• mild allergic reaction*

These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking meloxicam and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “Side effect specifics” below.

Meloxicam may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to meloxicam’s prescribing information.

If you develop serious side effects while taking meloxicam, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

• Anemia (low level of red blood cells). Symptoms can include:
  • lightheadedness
  • pale-looking skin
  • shortness of breath
• High blood potassium level. Symptoms can include:
  • nausea and vomiting
  • shortness of breath
  • muscle cramps
  • heart palpitations
• Severe skin reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms. Symptoms can include:
  • fever
  • swollen lymph nodes
  • painful rash
  • blisters or peeling skin around the eyes, mouth, or throat
• Fluid buildup, which may occur in the face, arms, or legs. Symptoms can include:
  • weight gain
  • shiny, stretched, or swollen skin around the affected area
  • pain or stiffness around the affected area
• Kidney damage. Symptoms can include:
  • fatigue
  • nausea and vomiting
  • loss of appetite
  • muscle cramps
• Liver damage. Symptoms can include:
  • fatigue
  • nausea
  • diarrhea
  • pain in the upper right abdomen
  • jaundice
• High blood pressure, which doesn’t typically cause symptoms.
• Heart problems.*
• Digestive system problems.*
• Severe allergic reaction.

* Meloxicam has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section below.

Meloxicam is approved to treat juvenile rheumatoid arthritis in children weighing at least 60 kilograms (kg), which is about 132 pounds (lb). (1 kg is about 2.2 lb.)

Most side effects of meloxicam in children are expected to be the same as those in adults. For details, see the “Meloxicam: Mild side effects” and “Meloxicam: Serious side effects” sections above.

However, the following side effects may be more common in children than in adults:

• certain digestive problems, such as diarrhea, vomiting, and abdominal pain
• fever
• headache

If you have questions about how meloxicam may affect your child, talk with their doctor.

Learn more about some of the side effects that meloxicam may cause. To find out how often side effects occurred in clinical trials, see the prescribing information for meloxicam.

Heart problems

Meloxicam has a boxed warning about the risk of heart problems. A boxed warning is a serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Taking meloxicam can increase the risk of certain heart problems, including heart attack and stroke. Heart attack was a rare side effect in clinical trials of meloxicam, and stroke was not reported as a side effect in the clinical trials. However, nonsteroidal anti-inflammatory drugs such as meloxicam can increase this risk.

Symptoms of a heart attack can include tightness, pressure, or pain in your chest that spreads to your jaw, neck, back, or arms. Symptoms of a stroke may include headache, weakness on one side of your body, and trouble walking, seeing, or speaking.

Several factors can increase your risk of heart problems with meloxicam. These include:

• taking high doses of the drug
• having heart problems or risk factors for heart problems, such as high blood pressure, high cholesterol, and smoking
• having had a recent heart attack or a certain heart surgery
• being an older adult (age 65 years and over)

Due to the risk of heart problems, your doctor will prescribe the lowest dose of meloxicam that’s effective for treating your condition. And they’ll prescribe this dosage for the shortest amount of time needed to treat your condition.

What you can do

Before taking meloxicam, be sure your doctor knows if you have heart problems or risk factors for heart problems. Also, tell them if you have a history of heart failure or if you’ve recently had a heart attack or heart surgery. They’ll likely prescribe a drug other than meloxicam to treat your condition.

If you have symptoms of heart attack or stroke while taking meloxicam, immediately call 911 or your local emergency number.

Digestive system problems

Meloxicam has a boxed warning about the risk of digestive system problems. A boxed warning is a serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.

Taking meloxicam can increase the risk of inflammation, bleeding, ulcers (sores), or perforations (tears) in your digestive system. (The digestive system includes your esophagus, stomach, small intestine, and large intestine.) These side effects were rare in clinical trials of meloxicam. However, they can be fatal.

Symptoms of digestive system problems can include bloody stool, nausea and vomiting, and abdominal or stomach pain.

Several factors can increase your risk of digestive system problems with meloxicam. These include:

• taking meloxicam long term
• having had ulcers or bleeding in your digestive system in the past
• having conditions that increase your risk of bleeding, such as hemophilia
• having severe liver problems, such as liver failure
• drinking alcohol or smoking
• being an older adult (age 65 years and over) or having other health conditions
• taking other medications that increase the risk of digestive system problems, including:
  • corticosteroids such as prednisone (Rayos)
  • blood thinners such as warfarin (Jantoven)
  • selective serotonin reuptake inhibitors such as sertraline (Zoloft) or citalopram (Celexa)
  • other nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen (Advil, Motrin)

What you can do

Before taking meloxicam, tell your doctor if you have any of the factors listed above that may increase your risk of digestive system problems. They’ll recommend whether it’s safe for you to take meloxicam.

If you have symptoms of digestive system problems while taking meloxicam, contact your doctor right away. However, if your symptoms feel severe or life threatening, immediately call 911 or your local emergency number.

Weight gain or weight loss

Weight gain or weight loss can occur with meloxicam. However, weight changes were rare in clinical trials of the drug.

Keep in mind that meloxicam may cause fluid buildup in the face, arms, or legs. And fluid buildup may cause weight gain for some people.

What you can do

If you’re concerned about weight changes while taking meloxicam, talk with your doctor. They can advise you on your risk of weight gain or weight loss. Your doctor can also recommend ways to maintain a weight that’s healthy for you.

Headache

Meloxicam may cause headache. This was one of the most common side effects in clinical trials of the drug.

With headache, you may have pain on one or both sides of your head. This pain may come on suddenly or gradually, and it may last for several hours.

It’s important to remember that headache can be a symptom of stroke. Meloxicam has a boxed warning about the risk of heart problems, including stroke. For details, see “Heart problems” above.

What you can do

If you have a headache with meloxicam that’s bothersome or long lasting, talk with your doctor. They can recommend ways to ease this side effect.

Keep in mind that meloxicam belongs to a drug class called nonsteroidal anti-inflammatory drugs (NSAIDs). Certain NSAIDs are available without a prescription and may be used to relieve pain, including headache pain. Examples include ibuprofen (Advil, Motrin) and naproxen (Aleve).

However, your doctor will likely recommend that you avoid taking other NSAIDs with meloxicam. This is because taking meloxicam with other NSAIDs can increase your risk of digestive system problems. Meloxicam has a boxed warning about this risk. For details, see “Digestive system problems” above.

Joint pain

Joint pain may occur with meloxicam. This was a less common side effect in clinical trials of the drug.

With joint pain, you may have swelling, stiffness, or tenderness in the affected joint.

Remember that meloxicam is used to treat conditions that cause joint pain. These include osteoarthritis (OA) and rheumatoid arthritis (RA). So it’s possible that joint pain with meloxicam may be related to OA or RA rather than the drug itself.

What you can do

If you have joint pain with meloxicam, talk with your doctor. They can help you determine whether the joint pain may be related to meloxicam or the condition the drug is treating. Your doctor can recommend ways to manage this side effect.

It’s important to remember that meloxicam should not be taken with other nonsteroidal anti-inflammatory drugs (NSAIDs). (NSAID is the drug class that meloxicam belongs to.) Certain NSAIDs are available without a prescription and may be used to relieve pain, including joint pain. Examples include ibuprofen (Advil, Motrin) and naproxen (Aleve).

However, your doctor will likely recommend that you avoid taking other NSAIDs with meloxicam. This is because taking meloxicam with other NSAIDs can increase your risk of digestive system problems. Meloxicam has a boxed warning about this risk. For details, see “Digestive system problems” above.

Allergic reaction

As with most drugs, meloxicam can cause an allergic reaction in some people. However, this side effect was rare in clinical trials.

Symptoms can be mild or serious and can include:

• skin rash
• itching
• flushing
• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking meloxicam. However, if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Meloxicam may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Are side effects of meloxicam the same with 7.5-mg and the 15-mg tablets?

Yes, the side effects of meloxicam are expected to be the same regardless of the strength you take. In clinical trials, similar side effects were reported for the 7.5-milligram (mg) and 15-mg strengths.

However, your risk of certain side effects may be greater at higher doses of meloxicam. For example, taking higher doses of meloxicam may increase your risk of heart problems* as a side effect.

To learn more about what to expect with the 7.5-mg and 15-mg tablets of meloxicam, talk with your doctor.

* Meloxicam has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section above.

Do meloxicam’s side effects vary between adults and children?

Not necessarily. The side effects of meloxicam are expected to be the same in adults and children. For details about specific side effects that may occur, see the “Meloxicam: Mild side effects” and “Meloxicam: Serious side effects” sections above.

However, certain side effects may be more common in children than in adults. To learn more about meloxicam’s side effects in children, see the “Meloxicam: Side effects in children” section above.

Is tingling a side effect of taking meloxicam?

It’s possible. Paresthesia was a rare side effect in clinical trials of meloxicam. With paresthesia, you may have tingling, numbness, or burning in your arms, hands, legs, or feet.

If you have bothersome symptoms of paresthesia while taking meloxicam, talk with your doctor. They can recommend ways to manage this side effect. For example, your doctor may switch you to a treatment other than meloxicam that isn’t known to cause this side effect.

Meloxicam may cause hair loss. This side effect was rare in clinical trials of the drug.

Keep in mind that meloxicam is used to treat rheumatoid arthritis (RA), which may also cause hair loss. If you’re taking meloxicam to treat RA, you may have hair loss related to your condition.

If you’re concerned about hair loss with meloxicam, talk with your doctor. They can discuss your risk of this side effect. And they can suggest ways to manage hair loss if it happens.

In older adults (ages 65 years and over), the side effects of meloxicam are expected to be the same as for younger adults. For details about specific side effects that may occur, see the “Meloxicam: Mild side effects” and “Meloxicam: Serious side effects” sections above.

However, older adults may have an increased risk of certain side effects when compared with younger adults. Examples of these side effects can include:

• kidney damage
• heart problems*
• digestive system problems*

Due to these risks, doctors may prescribe a lower dosage of meloxicam for older adults. For details about meloxicam’s dosage, see this article.

If you have questions about meloxicam’s side effects in older adults, talk with your doctor or pharmacist.

* Meloxicam has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section above.

Meloxicam comes with several precautions that may determine whether you can safely take the medication. Keep reading to learn more.

Boxed warnings

This drug has boxed warnings about risks of heart problems and digestive system problems. These are serious warnings from the Food and Drug Administration (FDA). For details, see the “Side effect specifics” section above.

Other precautions

Be sure to talk with your doctor about your health history before you take meloxicam. This drug may not be the right treatment option for you if you have certain medical conditions or other factors that affect your health. These are known as drug-condition or drug-factor interactions. The conditions and factors to consider include:

Asthma. Meloxicam may worsen asthma in certain people with this condition. This risk is especially high in people who have asthma that has worsened in the past after taking aspirin or another nonsteroidal anti-inflammatory drug (NSAID). (NSAID is the drug class meloxicam belongs to.) Your doctor can recommend whether it’s safe for you to take meloxicam.

Heart failure. Meloxicam can worsen heart failure in people who already have this condition. Due to this risk, your doctor may not prescribe meloxicam for you if you have heart failure.

High blood pressure. Meloxicam may cause high blood pressure. Be sure to tell your doctor if you already have high blood pressure or take medications for this condition. Meloxicam could increase your blood pressure further, which could make blood pressure medications less effective. If you take meloxicam, your doctor may watch your blood pressure more closely than is typical during treatment.

Kidney or liver problems. Before taking meloxicam, tell your doctor if you have kidney or liver problems. Examples include kidney or liver failure. Meloxicam may worsen your condition. Your doctor can tell you whether it’s safe to take meloxicam while you have kidney or liver problems. In some cases, they may prescribe meloxicam at a lower dosage. Or they may prescribe a drug other than meloxicam for you.

Allergic reaction. If you’ve had an allergic reaction to meloxicam or any of its ingredients, your doctor will likely not prescribe meloxicam. Taking meloxicam could cause you to have another allergic reaction. Ask your doctor what other medications may be better options for you.

Alcohol with meloxicam

You should not take meloxicam with alcohol. Doing so could increase your risk of digestive system problems with the drug. Meloxicam has a boxed warning for this side effect. This is the most serious warning from the FDA. To learn more, see the “Side effect specifics” section above.

If you have questions about alcohol and meloxicam, talk with your doctor.

Pregnancy and breastfeeding while taking meloxicam

Below is important information about taking meloxicam while pregnant or breastfeeding.

Pregnancy

It may not be safe to take meloxicam during pregnancy, especially between week 30 of pregnancy and birth. Doing so may cause certain heart and kidney problems in a fetus.

In certain cases, your doctor may tell you it’s safe to take meloxicam before week 30 of pregnancy. If so, they’ll prescribe meloxicam at the lowest dosage and for the shortest amount of time needed to treat your condition.

If you’re pregnant or planning to become pregnant, talk with your doctor before taking meloxicam.

Breastfeeding

It’s not known whether meloxicam is safe to take while breastfeeding. It’s not known whether the drug passes into breast milk or what effects it may have on a child who is breastfed.

If you’re breastfeeding or planning to do so, talk with your doctor before taking meloxicam. They can talk with you about the risks and benefits of breastfeeding while taking the drug.

Meloxicam may cause mild and serious side effects. If you have bothersome or long lasting side effects with meloxicam, talk with your doctor or pharmacist.

If you’d like to learn more about meloxicam, talk with your doctor or pharmacist. They can help answer any questions you have about side effects of taking the drug. Referring to the following articles about meloxicam can provide you with additional information:

• More information about meloxicam. For details about other aspects of meloxicam, refer to this article. You can also view this article about meloxicam and liver damage.
• A look at your condition. For details about arthritis, see our arthritis hub. To learn about rheumatoid arthritis, view our rheumatoid arthritis hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Meloxicam oral tablet side effects: How to manage

Meloxicam (Mobic, Anjeso) is a generic prescription medication. Meloxicam comes as an oral tablet and oral capsule. Both forms of meloxicam are used to treat osteoarthritis. In addition, meloxicam oral tablet is used to treat rheumatoid arthritis (RA) and juvenile RA.

Meloxicam may be used as a short-term or long-term treatment. As with other drugs, meloxicam can cause side effects.

This article focuses on just the oral tablet form of meloxicam, which is available as the brand-name drug Mobic. Read on to learn about its potential common, mild, and serious side effects. For a general overview of meloxicam, including details about its uses, refer to this article. Your doctor can also tell you more about meloxicam.

Meloxicam can cause certain side effects, some of which are more common than others. These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

These are just a few of the more common side effects reported by people who took meloxicam in clinical trials:

• upper respiratory infection, such as the common cold
• flu-like symptoms, such as fever, chills, or sore throat
• digestive problems, such as abdominal pain, constipation, and diarrhea
• headache*

* For more information about this side effect, see “Side effect specifics” below.

Mild side effects can occur with meloxicam use. This list doesn’t include all possible mild side effects of the drug. For more information, you can refer to meloxicam’s prescribing information.

Mild side effects that have been reported with meloxicam include:

• mild infections, including urinary tract infection (UTI) and upper respiratory infection, such as the common cold
• flu-like symptoms, such as fever, chills, or sore throat
• dizziness
• back pain
• insomnia
• rash or itchiness
• sleepiness or drowsiness
• digestive problems, such as abdominal pain, constipation, and diarrhea
• weight gain or weight loss*
• headache*
• joint pain*
• mild allergic reaction*

These side effects may be temporary, lasting a few days to weeks. However, if the side effects last longer than that, bother you, or become severe, be sure to talk with your doctor or pharmacist.

Note: After the Food and Drug Administration (FDA) approves a drug, it tracks side effects of the medication. If you develop a side effect while taking meloxicam and want to tell the FDA about it, visit MedWatch.

* For more information about this side effect, see “Side effect specifics” below.

Meloxicam may cause serious side effects. The list below may not include all possible serious side effects of the drug. For more information, you can refer to meloxicam’s prescribing information.

If you develop serious side effects while taking meloxicam, call your doctor right away. If the side effects seem life threatening or you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Serious side effects that have been reported and their symptoms include:

• Anemia (low level of red blood cells). Symptoms can include:
  • lightheadedness
  • pale-looking skin
  • shortness of breath
• High blood potassium level. Symptoms can include:
  • nausea and vomiting
  • shortness of breath
  • muscle cramps
  • heart palpitations
• Severe skin reactions, such as Stevens-Johnson syndrome, toxic epidermal necrolysis, and drug rash with eosinophilia and systemic symptoms. Symptoms can include:
  • fever
  • swollen lymph nodes
  • painful rash
  • blisters or peeling skin around the eyes, mouth, or throat
• Fluid buildup, which may occur in the face, arms, or legs. Symptoms can include:
  • weight gain
  • shiny, stretched, or swollen skin around the affected area
  • pain or stiffness around the affected area
• Kidney damage. Symptoms can include:
  • fatigue
  • nausea and vomiting
  • loss of appetite
  • muscle cramps
• Liver damage. Symptoms can include:
  • fatigue
  • nausea
  • diarrhea
  • pain in the upper right abdomen
  • jaundice
• High blood pressure, which doesn’t typically cause symptoms.
• Heart problems.*
• Digestive system problems.*
• Severe allergic reaction.

* Meloxicam has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section below.

Meloxicam is approved to treat juvenile rheumatoid arthritis in children weighing at least 60 kilograms (kg), which is about 132 pounds (lb). (1 kg is about 2.2 lb.)

Most side effects of meloxicam in children are expected to be the same as those in adults. For details, see the “Meloxicam: Mild side effects” and “Meloxicam: Serious side effects” sections above.

However, the following side effects may be more common in children than in adults:

• certain digestive problems, such as diarrhea, vomiting, and abdominal pain
• fever
• headache

If you have questions about how meloxicam may affect your child, talk with their doctor.

Learn more about some of the side effects that meloxicam may cause. To find out how often side effects occurred in clinical trials, see the prescribing information for meloxicam.

Heart problems

Meloxicam has a boxed warning about the risk of heart problems. A boxed warning is a serious warning from the Food and Drug Administration (FDA). It alerts doctors and patients about drug effects that may be dangerous.

Taking meloxicam can increase the risk of certain heart problems, including heart attack and stroke. Heart attack was a rare side effect in clinical trials of meloxicam, and stroke was not reported as a side effect in the clinical trials. However, nonsteroidal anti-inflammatory drugs such as meloxicam can increase this risk.

Symptoms of a heart attack can include tightness, pressure, or pain in your chest that spreads to your jaw, neck, back, or arms. Symptoms of a stroke may include headache, weakness on one side of your body, and trouble walking, seeing, or speaking.

Several factors can increase your risk of heart problems with meloxicam. These include:

• taking high doses of the drug
• having heart problems or risk factors for heart problems, such as high blood pressure, high cholesterol, and smoking
• having had a recent heart attack or a certain heart surgery
• being an older adult (age 65 years and over)

Due to the risk of heart problems, your doctor will prescribe the lowest dose of meloxicam that’s effective for treating your condition. And they’ll prescribe this dosage for the shortest amount of time needed to treat your condition.

What you can do

Before taking meloxicam, be sure your doctor knows if you have heart problems or risk factors for heart problems. Also, tell them if you have a history of heart failure or if you’ve recently had a heart attack or heart surgery. They’ll likely prescribe a drug other than meloxicam to treat your condition.

If you have symptoms of heart attack or stroke while taking meloxicam, immediately call 911 or your local emergency number.

Digestive system problems

Meloxicam has a boxed warning about the risk of digestive system problems. A boxed warning is a serious warning from the FDA. It alerts doctors and patients about drug effects that may be dangerous.

Taking meloxicam can increase the risk of inflammation, bleeding, ulcers (sores), or perforations (tears) in your digestive system. (The digestive system includes your esophagus, stomach, small intestine, and large intestine. ) These side effects were rare in clinical trials of meloxicam. However, they can be fatal.

Symptoms of digestive system problems can include bloody stool, nausea and vomiting, and abdominal or stomach pain.

Several factors can increase your risk of digestive system problems with meloxicam. These include:

• taking meloxicam long term
• having had ulcers or bleeding in your digestive system in the past
• having conditions that increase your risk of bleeding, such as hemophilia
• having severe liver problems, such as liver failure
• drinking alcohol or smoking
• being an older adult (age 65 years and over) or having other health conditions
• taking other medications that increase the risk of digestive system problems, including:
  • corticosteroids such as prednisone (Rayos)
  • blood thinners such as warfarin (Jantoven)
  • selective serotonin reuptake inhibitors such as sertraline (Zoloft) or citalopram (Celexa)
  • other nonsteroidal anti-inflammatory drugs such as aspirin or ibuprofen (Advil, Motrin)

What you can do

Before taking meloxicam, tell your doctor if you have any of the factors listed above that may increase your risk of digestive system problems. They’ll recommend whether it’s safe for you to take meloxicam.

If you have symptoms of digestive system problems while taking meloxicam, contact your doctor right away. However, if your symptoms feel severe or life threatening, immediately call 911 or your local emergency number.

Weight gain or weight loss

Weight gain or weight loss can occur with meloxicam. However, weight changes were rare in clinical trials of the drug.

Keep in mind that meloxicam may cause fluid buildup in the face, arms, or legs. And fluid buildup may cause weight gain for some people.

What you can do

If you’re concerned about weight changes while taking meloxicam, talk with your doctor. They can advise you on your risk of weight gain or weight loss. Your doctor can also recommend ways to maintain a weight that’s healthy for you.

Headache

Meloxicam may cause headache. This was one of the most common side effects in clinical trials of the drug.

With headache, you may have pain on one or both sides of your head. This pain may come on suddenly or gradually, and it may last for several hours.

It’s important to remember that headache can be a symptom of stroke. Meloxicam has a boxed warning about the risk of heart problems, including stroke. For details, see “Heart problems” above.

What you can do

If you have a headache with meloxicam that’s bothersome or long lasting, talk with your doctor. They can recommend ways to ease this side effect.

Keep in mind that meloxicam belongs to a drug class called nonsteroidal anti-inflammatory drugs (NSAIDs). Certain NSAIDs are available without a prescription and may be used to relieve pain, including headache pain. Examples include ibuprofen (Advil, Motrin) and naproxen (Aleve).

However, your doctor will likely recommend that you avoid taking other NSAIDs with meloxicam. This is because taking meloxicam with other NSAIDs can increase your risk of digestive system problems. Meloxicam has a boxed warning about this risk. For details, see “Digestive system problems” above.

Joint pain

Joint pain may occur with meloxicam. This was a less common side effect in clinical trials of the drug.

With joint pain, you may have swelling, stiffness, or tenderness in the affected joint.

Remember that meloxicam is used to treat conditions that cause joint pain. These include osteoarthritis (OA) and rheumatoid arthritis (RA). So it’s possible that joint pain with meloxicam may be related to OA or RA rather than the drug itself.

What you can do

If you have joint pain with meloxicam, talk with your doctor. They can help you determine whether the joint pain may be related to meloxicam or the condition the drug is treating. Your doctor can recommend ways to manage this side effect.

It’s important to remember that meloxicam should not be taken with other nonsteroidal anti-inflammatory drugs (NSAIDs). (NSAID is the drug class that meloxicam belongs to.) Certain NSAIDs are available without a prescription and may be used to relieve pain, including joint pain. Examples include ibuprofen (Advil, Motrin) and naproxen (Aleve).

However, your doctor will likely recommend that you avoid taking other NSAIDs with meloxicam. This is because taking meloxicam with other NSAIDs can increase your risk of digestive system problems. Meloxicam has a boxed warning about this risk. For details, see “Digestive system problems” above.

Allergic reaction

As with most drugs, meloxicam can cause an allergic reaction in some people. However, this side effect was rare in clinical trials.

Symptoms can be mild or serious and can include:

• skin rash
• itching
• flushing
• swelling under your skin, typically in your eyelids, lips, hands, or feet
• swelling of your mouth, tongue, or throat, which can make it hard to breathe

What you can do

For mild symptoms of an allergic reaction, call your doctor right away. They may recommend ways to ease your symptoms and determine whether you should keep taking meloxicam. However, if your symptoms are serious and you think you’re having a medical emergency, immediately call 911 or your local emergency number.

Meloxicam may cause several side effects. Here are some frequently asked questions about the drug’s side effects and their answers.

Are side effects of meloxicam the same with 7.5-mg and the 15-mg tablets?

Yes, the side effects of meloxicam are expected to be the same regardless of the strength you take. In clinical trials, similar side effects were reported for the 7.5-milligram (mg) and 15-mg strengths.

However, your risk of certain side effects may be greater at higher doses of meloxicam. For example, taking higher doses of meloxicam may increase your risk of heart problems* as a side effect.

To learn more about what to expect with the 7.5-mg and 15-mg tablets of meloxicam, talk with your doctor.

* Meloxicam has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section above.

Do meloxicam’s side effects vary between adults and children?

Not necessarily. The side effects of meloxicam are expected to be the same in adults and children. For details about specific side effects that may occur, see the “Meloxicam: Mild side effects” and “Meloxicam: Serious side effects” sections above.

However, certain side effects may be more common in children than in adults. To learn more about meloxicam’s side effects in children, see the “Meloxicam: Side effects in children” section above.

Is tingling a side effect of taking meloxicam?

It’s possible. Paresthesia was a rare side effect in clinical trials of meloxicam. With paresthesia, you may have tingling, numbness, or burning in your arms, hands, legs, or feet.

If you have bothersome symptoms of paresthesia while taking meloxicam, talk with your doctor. They can recommend ways to manage this side effect. For example, your doctor may switch you to a treatment other than meloxicam that isn’t known to cause this side effect.

Meloxicam may cause hair loss. This side effect was rare in clinical trials of the drug.

Keep in mind that meloxicam is used to treat rheumatoid arthritis (RA), which may also cause hair loss. If you’re taking meloxicam to treat RA, you may have hair loss related to your condition.

If you’re concerned about hair loss with meloxicam, talk with your doctor. They can discuss your risk of this side effect. And they can suggest ways to manage hair loss if it happens.

In older adults (ages 65 years and over), the side effects of meloxicam are expected to be the same as for younger adults. For details about specific side effects that may occur, see the “Meloxicam: Mild side effects” and “Meloxicam: Serious side effects” sections above.

However, older adults may have an increased risk of certain side effects when compared with younger adults. Examples of these side effects can include:

• kidney damage
• heart problems*
• digestive system problems*

Due to these risks, doctors may prescribe a lower dosage of meloxicam for older adults. For details about meloxicam’s dosage, see this article.

If you have questions about meloxicam’s side effects in older adults, talk with your doctor or pharmacist.

* Meloxicam has a boxed warning for this side effect. This is the most serious warning from the Food and Drug Administration (FDA). To learn more, see the “Side effect specifics” section above.

Meloxicam comes with several precautions that may determine whether you can safely take the medication. Keep reading to learn more.

Boxed warnings

This drug has boxed warnings about risks of heart problems and digestive system problems. These are serious warnings from the Food and Drug Administration (FDA). For details, see the “Side effect specifics” section above.

Other precautions

Be sure to talk with your doctor about your health history before you take meloxicam. This drug may not be the right treatment option for you if you have certain medical conditions or other factors that affect your health. These are known as drug-condition or drug-factor interactions. The conditions and factors to consider include:

Asthma. Meloxicam may worsen asthma in certain people with this condition. This risk is especially high in people who have asthma that has worsened in the past after taking aspirin or another nonsteroidal anti-inflammatory drug (NSAID). (NSAID is the drug class meloxicam belongs to.) Your doctor can recommend whether it’s safe for you to take meloxicam.

Heart failure. Meloxicam can worsen heart failure in people who already have this condition. Due to this risk, your doctor may not prescribe meloxicam for you if you have heart failure.

High blood pressure. Meloxicam may cause high blood pressure. Be sure to tell your doctor if you already have high blood pressure or take medications for this condition. Meloxicam could increase your blood pressure further, which could make blood pressure medications less effective. If you take meloxicam, your doctor may watch your blood pressure more closely than is typical during treatment.

Kidney or liver problems. Before taking meloxicam, tell your doctor if you have kidney or liver problems. Examples include kidney or liver failure. Meloxicam may worsen your condition. Your doctor can tell you whether it’s safe to take meloxicam while you have kidney or liver problems. In some cases, they may prescribe meloxicam at a lower dosage. Or they may prescribe a drug other than meloxicam for you.

Allergic reaction. If you’ve had an allergic reaction to meloxicam or any of its ingredients, your doctor will likely not prescribe meloxicam. Taking meloxicam could cause you to have another allergic reaction. Ask your doctor what other medications may be better options for you.

Alcohol with meloxicam

You should not take meloxicam with alcohol. Doing so could increase your risk of digestive system problems with the drug. Meloxicam has a boxed warning for this side effect. This is the most serious warning from the FDA. To learn more, see the “Side effect specifics” section above.

If you have questions about alcohol and meloxicam, talk with your doctor.

Pregnancy and breastfeeding while taking meloxicam

Below is important information about taking meloxicam while pregnant or breastfeeding.

Pregnancy

It may not be safe to take meloxicam during pregnancy, especially between week 30 of pregnancy and birth. Doing so may cause certain heart and kidney problems in a fetus.

In certain cases, your doctor may tell you it’s safe to take meloxicam before week 30 of pregnancy. If so, they’ll prescribe meloxicam at the lowest dosage and for the shortest amount of time needed to treat your condition.

If you’re pregnant or planning to become pregnant, talk with your doctor before taking meloxicam.

Breastfeeding

It’s not known whether meloxicam is safe to take while breastfeeding. It’s not known whether the drug passes into breast milk or what effects it may have on a child who is breastfed.

If you’re breastfeeding or planning to do so, talk with your doctor before taking meloxicam. They can talk with you about the risks and benefits of breastfeeding while taking the drug.

Meloxicam may cause mild and serious side effects. If you have bothersome or long lasting side effects with meloxicam, talk with your doctor or pharmacist.

If you’d like to learn more about meloxicam, talk with your doctor or pharmacist. They can help answer any questions you have about side effects of taking the drug. Referring to the following articles about meloxicam can provide you with additional information:

• More information about meloxicam. For details about other aspects of meloxicam, refer to this article. You can also view this article about meloxicam and liver damage.
• A look at your condition. For details about arthritis, see our arthritis hub. To learn about rheumatoid arthritis, view our rheumatoid arthritis hub.

Disclaimer: Medical News Today has made every effort to make certain that all information is factually correct, comprehensive, and up to date. However, this article should not be used as a substitute for the knowledge and expertise of a licensed healthcare professional. You should always consult your doctor or another healthcare professional before taking any medication. The drug information contained herein is subject to change and is not intended to cover all possible uses, directions, precautions, warnings, drug interactions, allergic reactions, or adverse effects. The absence of warnings or other information for a given drug does not indicate that the drug or drug combination is safe, effective, or appropriate for all patients or all specific uses.

Meloxicam in the treatment of chronic diseases of the musculoskeletal system | #04/11

Millions of people suffer from pain in the joints and spine in various rheumatic diseases, pain in the periarticular tissues and muscles accompany many diseases or arise as an independent suffering. The most common diseases that occur with chronic pain syndrome are rheumatoid arthritis (RA), spondyloarthropathies (SA) and osteoarthritis (OA). At various periods of life, pain due to damage to the components of the musculoskeletal system occurs in 20–45% of the world’s population, more often in women than in men, and in older age groups [1].

The chronic nature of the pain syndrome of most rheumatic diseases is due to the development of inflammation in the synovial membrane of the joints due to the hyperproduction of a large number of pro-inflammatory agents, modulation of the function of immunocompetent cells and their proliferation, and the destructive action of proteases [2]. Even OA, a disease that is commonly referred to as degenerative joint disease, is also characterized by the development of synovitis and is an indication for prescribing drugs that stop the inflammatory process. Pain syndrome inevitably accompanies inflammation in the joint, although its intensity does not always correlate with the severity of inflammation.

Anti-inflammatory therapy of chronic inflammatory arthropathies is carried out for a long time, since in diseases such as RA, SA, spontaneous remissions are practically absent. Therefore, patients are forced to take drugs that reduce pain and inflammation for many months and years. The need for long-term therapy makes symptomatic treatment require rapid development of the effect, the severity of the effect, and tolerability with long-term use.

The treatment of patients with OA is complicated by the advanced age of most patients, the presence of concomitant diseases and the need for concomitant therapy. All of these factors are risk factors for the development of complications of anti-inflammatory drugs. The problem of comorbidity in OA is always a concern for clinicians. In recent years, more and more new data have appeared on the frequency of comorbidity in patients with diseases of the musculoskeletal system, primarily in patients with OA. Over 9 surveys000 patients in Serbia [3] (Fig. 1), comorbidity was detected in more than 60% of patients.

In a case-control study [4], conducted in the UK, when comparing the incidence of comorbidity in 11,375 patients with OA in comparison with 11,780 individuals without OA, an increase in the incidence of OA was found: obesity by 2.25 times, gastritis by 1.98 times, phlebitis – 1.8 times, diaphragmatic hernia – 1.8 times, coronary heart disease (CHD) – 1.73 times, intestinal diverticulosis – 1.63 times. According to many authors, the most common comorbid conditions are arterial hypertension, coronary artery disease, and diabetes [3–9]. On the one hand, they are well-known risk factors for intolerance to non-steroidal anti-inflammatory drugs (NSAIDs). On the other hand, taking NSAIDs aggravates the course of arterial hypertension (AH), reduces the effectiveness of antihypertensive therapy, and can aggravate congestive heart failure (CHF) [10–13]. The increase in the frequency of NSAIDs – gastropathy in the elderly is well known (Fig. 2). To a lesser extent, it is covered in the literature that taking NSAIDs doubles the risk of developing CHF and doubles the risk of hospitalization for CHF [12, 13], and in people with CHF, taking NSAIDs increases the risk of its increase by 10.5 times [ 12].

Thus, the requirements for drug therapy that can reduce the severity of inflammation and pain, taking into account the need for long-term use of drugs, are determined by the severity of the analgesic and anti-inflammatory effect and their safety.

The selective inhibitor of cyclooxygenase-2 (COX-2) meloxicam is widely used in medical practice. Meloxicam is a derivative of oxicamic acid and has a long half-life: the maximum concentration (Cmax) in plasma after taking 15 mg of the drug is reached after 7 hours, the half-life is 20-24 hours, so it is prescribed 1 time per day at a dose of 7.5 or 15 mg, which is convenient for the patient. Meloxicam is structurally different from other COX-2 inhibitors, such as “coxibs”, and binds to the upper part of the COX-2 channel, and not to the side of this enzyme, like celecoxib. Meloxicam binds well to plasma proteins (99.5%) and easily penetrates into the synovial fluid, where its concentration is 45–57% of the plasma concentration [10].

The efficacy of meloxicam was evaluated in a number of large randomized clinical trials (RCTs) in OA (MELISSA study, n = 9323; SELECT, n = 8656; in the USA, n = 774), in RA (n = 894), ankylosing spondylitis (AS) ( n = 473) (Fig. 2, 3).

It has been shown that the effectiveness of meloxicam in the treatment of patients with OA is equal to that of non-selective NSAIDs (diclofenac, piroxicam) [14], and the tolerability is much better [17, 18] (Fig. 4). The drug demonstrated equivalent efficacy with non-selective NSAIDs in both RA and ankylosing spondylitis [15, 16].

Recently, a new parenteral form of meloxicam for intramuscular administration has been introduced into medical practice. The need to create this form is due to the fact that, due to the significant half-life of meloxicam, its concentration when taking the tablet form is stabilized in the patient’s blood only for 3-4 days. Therefore, for the rapid relief of severe or acute pain, a parenteral form was developed. Pharmacokinetic studies have shown that intramuscular use of meloxicam leads to faster absorption of the drug than with oral administration; maximum plasma concentration is reached as early as 1.5 hours after IM administration compared with 5-7 hours after oral administration [19]. At the same time, 90% Cmax is achieved within 30-50 minutes after the injection. This increase in absorption determines the more rapid onset of action of meloxicam administered intramuscularly compared to oral administration (Fig. 5).

For IM administration to be considered as an alternative to the oral route, very good local tolerance is required. However, many NSAIDs are poorly tolerated when administered intramuscularly, causing local tissue irritation and necrosis, often in combination with systemic adverse events [20]. When working on rabbits, it was shown that the local tolerance of meloxicam is better than that of other NSAIDs. After its intramuscular injection, no histopathological changes were found, while when using piroxicam or diclofenac, an extensive area of ​​necrosis developed.

The advantage of using the intramuscular form of meloxicam compared to the tablet form was demonstrated in RA [20, 21], OA [21], and lumbar ischial syndrome [22]. A Russian multicenter study on the effectiveness of the intramuscular form of meloxicam in the treatment of 670 patients with joint pathology (OA – 384 patients and RA – 286 patients) showed that the effect of meloxicam administration into the muscle develops in most patients within the first hour after 1- th injection, increases during the first three days and then continues to increase when switching to the oral form, so that by the end of the course of treatment, a significant reduction in pain (at rest and during movement) and improvement in function was obtained (Fig. 6).

Such a stepwise method of prescribing meloxicam – intramuscular injection of the drug for three days and the subsequent transition to a tablet form can be especially useful in the treatment of arthrosis of the intervertebral joints and other causes of back pain (osteochondrosis), where the severity and severity of pain can be much greater than in peripheral joint OA. When comparing the efficacy and tolerability of parenteral forms of meloxicam and piroxicam in the treatment of acute pain in the shoulder joint in 599 patients after 7 days, the degree of pain reduction was equal in both groups of patients. However, meloxicam had a faster onset of action: in the first 3 days of therapy, pain decreased with injections of 7.5-15 mg of meloxicam in more patients than among those who received injections of 20 mg of piroxicam [23].

This is due to the differences in the pharmacokinetics of these two drugs (meloxicam reaches a stable plasma concentration after 3–4 days, and piroxicam after 7–10 days). It should be borne in mind that piroxicam is one of the most poorly tolerated NSAIDs, the use of which in the elderly in patients with OA is highly undesirable, therefore, piroxicam is usually used in the treatment of young people who do not have concomitant pathologies. A rapid decrease in spontaneous pain and pain during movement occurs when using the parenteral form of meloxicam in the treatment of exacerbation of the lumbar ischial syndrome (radiculopathy, myofascial and muscular tonic disorders) [22], when the speed of the development of the effect is necessary not only because of the severity of pain, but also to prevent the development of the effect “secondary hyperalgesia” and chronicity of the pathological process. The administration of meloxicam intramuscularly made it possible to achieve a decrease in 1 hour after the 1st injection of spontaneous pain by about 2 times, and pain during movement – by more than 2 times, and after the 3rd injection – by 77% and 78%, respectively.

The safety of meloxicam in the treatment of major rheumatological diseases of the joints and spine was assessed in a 1999 meta-analysis [24], which included data from 10 studies (Fig. 7).

Based on a meta-analysis of 10 published studies, meloxicam was superior to diclofenac, piroxicam and naproxen:

• by the number of complications from the gastrointestinal tract: risk reduction by ~36%;
• by the frequency of withdrawal due to complications from the gastrointestinal tract: risk reduction by ~41%;
• by frequency of perforations, ulcers, bleeding from the upper gastrointestinal tract: risk reduction by ~ 48%;
• by the incidence of dyspepsia: risk reduction by ~27%.

Randomized clinical trials have shown high safety of meloxicam. Over the past decade, a lot of experience has been accumulated in the use of meloxicam in real clinical practice, when treatment is carried out in patients of various ages, who have concomitant and sometimes severe diseases, and who receive various medications, which complicates analgesic and anti-inflammatory therapy.

Presented by Zeidler H. et al. [25] data on the results of treatment of 13,307 patients with joint pathology in ordinary medical practice in Germany allow us to assess the place of meloxicam in the opinion of 2,155 physicians. The majority of patients (60%) received other NSAIDs before prescribing meloxicam: in 43.2% of cases, their administration was not effective, and in every 5th patient it was not tolerated. In this group of patients, the frequency of adverse reactions leading to drug withdrawal when taking 7.5 mg/day of meloxicam was 0.7% and 15 mg/day – 0.6%; the development of complicated gastrointestinal ulcers was noted in 2 out of 8652 patients who received 7. 5 mg / day of meloxicam, and in another 2 out of 4448 patients with a daily dose of meloxicam 15 mg. Recall that the use of non-selective NSAIDs leads to the development of ulcers of the upper gastrointestinal tract in 12–19% of cases, and complicated ulcers in about 0.4% of cases [26]. At the same time, in many patients (up to 80%), the occurrence of ulcerative damage to the gastrointestinal mucosa occurs painlessly [26], which prevents the timely appointment of gastroprotective therapy.

In a pharmacoeconomic study of the safety of meloxicam in patients with risk factors for the development of NSAID gastropathy, compared with other NSAIDs [27], obvious evidence of a significantly better tolerability of meloxicam was obtained (Table 1),

including the frequency of bleeding from the upper gastrointestinal tract (Fig. 8).

The problems of NSAID-gastropathy are often discussed in the literature. Rarely are data on complications from the kidneys. Non-selective NSAIDs cause a decrease in the level of renal prostaglandins, which leads to a violation of Na excretion, fluid retention, the development of arterial hypertension or worsening of its course. At the same time, the effectiveness of antihypertensive drugs decreases, which dictates the need for careful monitoring of blood pressure and dose adjustment of beta-blockers, angiotensin-converting enzyme (ACE) inhibitors, and diuretics. According to the results of pathological and anatomical studies in patients with RA, who are forced to take full-fledged therapeutic doses of non-selective NSAIDs for years, interstitial nephritis is noted in 60-100%.

Perhaps the development of acute renal failure (ARF). A thorough analysis of the risk of developing AKI in elderly patients was carried out in the USA [28]. According to the program for evaluating the efficacy and safety of medicines prescribed between 1999 and 2004. people over 65 years of age, the side effects of NSAIDs were evaluated, provided they were taken for 6 or more months. Patients receiving two NSAIDs simultaneously were excluded from the study. Of 183,446 patients with a mean age of 78 years, AKI resulting in hospitalization occurred in 870 patients. The most common NSAID prescribed in this group of patients was celecoxib, which was taken by every third patient. In table. 2 shows the relative risk and 95% confidence interval for the development of acute renal failure when taking various NSAIDs compared with celecoxib.

A significant increase in the risk of developing AKI by 50% and 100% was obtained for ibuprofen and indomethacin, respectively. The table shows that meloxicam has the lowest risk of developing AKI among the analyzed selective and non-selective NSAIDs.

Both of these summaries are of undoubted interest to clinicians, since they are not based on the results of scientific studies, but on the basis of reports from practitioners.

In recent years, another aspect of the safety of NSAIDs has been discussed – the possibility of aggravating the course of cardiovascular diseases. Theoretically, an increase in the thrombogenic risk of selective cyclooxygenase type 2 inhibitors may be due to their inhibition of prostaglandin-I2 (“antithrombogenic” prostaglandin), a relative increase in the synthesis of thromboxane A2 (“thrombogenic” prostaglandin) when used in patients with RA or systemic lupus erythematosus, that is, in diseases in which the risk of thrombosis is increased. After data were obtained on a slight increase in the risk of cardiovascular diseases against the background of the use of rofecoxib [29], a number of additional studies have been conducted on the effect of NSAIDs on the functions of the cardiovascular system.

In 2001, the results of a meta-analysis of the results of treatment with meloxicam in 27,000 patients were reported [30]. According to these data, the frequency of cardiovascular adverse reactions in the treatment with meloxicam was not higher than when using non-selective NSAIDs. There is a report of a pilot study of the use of meloxicam at a dose of 15 mg intravenously in acute coronary syndrome in 60 patients receiving standard treatment with Aspirin and Heparin, compared with 60 patients receiving the same doses of Aspirin and Heparin without prescribing meloxicam. It turned out that the addition of meloxicam to standard therapy in assessing the outcomes of acute coronary syndrome (recurrent angina, myocardial infarction (MI) or death) led to a decrease in the frequency of negative outcomes from 38.3% to 15% during hospital stay and from 48, 3% to 26.7% in 90 days after treatment [31].

The risk of developing acute MI with the use of selective and non-selective NSAIDs was assessed in three populations in three countries (UK, Canada and the USA) [32]. The aim of the study was to evaluate the risk of MI in patients taking COX-2 inhibitors, meloxicam and other NSAIDs, compared with diclofenac; check the comparability of data for the three populations; a total of 60,473 cases of NSAID treatment and 248,768 controls were analyzed. The following results were obtained:

• Meloxicam was associated with a reduced risk of MI in one cohort, and no effect was found in two (although the relative risk was reduced in both studies).
• In one cohort, naproxen was associated with a reduced risk of MI, and in two, the risk was slightly increased.
• In two cohorts, the risk of MI was slightly increased with rofecoxib compared with diclofenac.
• In one cohort, a small increase in risk was found for ibuprofen compared with diclofenac.
• No differences were found between celecoxib and diclofenac.
• No significant differences were found in the UK GPRD, although the relative risk for meloxicam was below 1.0 and slightly increased for naproxen.
• The RAMQ (Canada) found a small statistically significant increase in risk with rofecoxib and a decrease in risk with meloxicam and naproxen.
• In VA (USA), a small but statistically significant increase in risk was found for rofecoxib, naproxen and ibuprofen and a decrease in risk for meloxicam.

The risk of MI in patients currently taking prescription NSAIDs (meloxicam, celecoxib, and rofecoxib) compared with current diclofenac is shown in Table. 3.

Thus, according to the results of RCTs and post-registration studies of meloxicam:

• Its distinct analgesic and anti-inflammatory activity was revealed in chronic diseases of the joints and spine, as well as in acute pain syndromes (lumboischalgia).
• Confirmed by the results of real clinical practice in the treatment of thousands of cohorts of patients with high gastrointestinal tolerance, previously identified in double-blind controlled studies.
• Large-scale pharmacoepidemiological studies confirm the low risk of severe gastrointestinal side effects previously established in controlled clinical trials and in the meta-analysis process.
• There was no increase in the frequency of cardiovascular toxicity.

These data are also confirmed by the IMPROVE study [33], which assessed the “therapeutic success” of meloxicam in OA. To assess “therapeutic success”, the following parameters were taken (endpoint): completion of the study without switching to another NSAID, or completion of the study and no need to take an NSAID. Meloxicam was prescribed to 662 patients and other NSAIDs to 647 patients. The endpoint was reached by 67% of the patients taking meloxicam and 45% of the patients from the control group (p < 0. 0005) (Fig. 9).

Cancellation of treatment due to adverse reactions was, respectively, in 12% and 20% of patients, due to lack of effect – in 16% and 28% of patients. Patients’ adherence to taking meloxicam testifies to the high efficiency of this drug.

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